04-10-2018, 15:27
Słowo odnośnie prążków -
The false diagnostic certainty the MacDonald criteria provide is likely responsible for several misdiagnoses. Take this certainty away, and it becomes a good idea to buttress these criteria with other tests such as the presence of cerebrospinal fluid (CSF) oligoclonal bands (OCB’s). The later has been reported present in over 85% of cases of MS. This data however dates back to the age of hospitals testing using their own unique laboratory recipe, leading to a high inter-laboratory variability. Recent studies have shown that CSF OCB results using standardized lab kits are now highly reliable within different hospitals. Since the adoption of these new laboratory kits the incidence of CSF OCB’s in MS, is probably much closer to 100% meaning that CSF OCB negative patients are unlikely to have MS or have a much less aggressive subtype of MS.
Więc generalnie, potwierdza to, to co pisałem - bałbym się zdiagnozować pacjenta, który nie ma prążków i ma stabilny obraz rezonansu + brak zmian w rdzeniu. To się na prawdę ekstremalnie rzadko zdarza, zazwyczaj ci pacjenci chorują na coś innego albo mają bardzo łagodny przebieg choroby (przynajmniej przez pierwsze kilkanaście/dziesiąt lat).
The false diagnostic certainty the MacDonald criteria provide is likely responsible for several misdiagnoses. Take this certainty away, and it becomes a good idea to buttress these criteria with other tests such as the presence of cerebrospinal fluid (CSF) oligoclonal bands (OCB’s). The later has been reported present in over 85% of cases of MS. This data however dates back to the age of hospitals testing using their own unique laboratory recipe, leading to a high inter-laboratory variability. Recent studies have shown that CSF OCB results using standardized lab kits are now highly reliable within different hospitals. Since the adoption of these new laboratory kits the incidence of CSF OCB’s in MS, is probably much closer to 100% meaning that CSF OCB negative patients are unlikely to have MS or have a much less aggressive subtype of MS.
Więc generalnie, potwierdza to, to co pisałem - bałbym się zdiagnozować pacjenta, który nie ma prążków i ma stabilny obraz rezonansu + brak zmian w rdzeniu. To się na prawdę ekstremalnie rzadko zdarza, zazwyczaj ci pacjenci chorują na coś innego albo mają bardzo łagodny przebieg choroby (przynajmniej przez pierwsze kilkanaście/dziesiąt lat).